Patterns of care in the early stages of Alzheimer's disease: impediments to timely diagnosis
Patterns of care in the early stages of Alzheimer's disease: impediments to timely diagnosis
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DOI：
10.1111/j.1532-5415.2000.tb02650.x
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发表时间：
2000-03-01
影响因子：
6.3
通讯作者：
Gutterman, EM
中科院分区：
文献类型：
--
作者：
Knopman, D;Donohue, JA;Gutterman, EM
目的：描述与阿尔茨海默病(AD)延迟诊断相关的因素。设计：一份自我管理的邮件问卷。设置：包括通过全国营销数据库确定的AD患者的家庭。部分：总共1480名被诊断为AD患者的照顾者：通过照顾者报告检查两种延迟测量：(1)从第一次AD症状到确定问题的几年时间，和(2)从问题发现到第一次医生会诊的时间。此外，照顾者根据患者确诊后的时间和与患者的关系进行分类。组内分析检验了这些特征对延迟措施的影响。结果：过去12个月、过去13至48个月和过去49个月或更长时间内确诊的患者从观察到第一症状到发现问题的平均滞后年分别为1.20、1.56和2.25(P<；.001)。诊断的时间也影响了从问题识别到第一次医生会诊的延迟，因此最近、较近和较远诊断的亚组报告的延迟分别为.82、.84和1.31年(P<；.001)。照顾者关系与这些滞后没有显著的关系。在最初的医生咨询中，照顾者只有38%的病例报告了AD的正确诊断。结论：这些结果表明，照顾者和医生都缺乏对衰老和AD记忆过程之间的差异的理解。需要进行持续的公共和专业教育，以传达诊断AD的基本知识。此外，应考虑对痴呆症进行常规筛查，以克服态度和后勤方面的障碍。
OBJECTIVE: Description of factors associated with delay in diagnosis of Alzheimer's disease (AD).DESIGN: A self-administered mail questionnaire.SETTING: Households including someone with AD identified through a nationwide marketing database.PARTICIPANTS: A total of 1480 caregivers of patients diagnosed with ADMEASUREMENTS: There were two measures of delay examined through caregiver reports: (1) duration in years from first AD signs until determination of a definite problem, and (2) duration from problem recognition to first physician consultation. Also, caregivers were categorized by time since patient's diagnosis and relationship to patient. Within-group analyses examined the impact of these characteristics on delay measures.RESULTS: Mean lag in years from observation of first symptoms to problem recognition for those diagnosed in the past 12 months, the past 13 to 48 months, and the past 49 months or more was, respectively, 1.20, 1.56, and 2.25 (P < .001). The timing of diagnosis also influenced lag from problem recognition to first physician consultation so that subgroups with recent, less recent, and distant diagnosis reported delays in years of .82, .84, and 1.31 (P < .001). Caregiver relationship was not significantly related to these lags. Correct diagnosis of AD was reported by caregivers in only 38% of cases at initial physician consultation.CONCLUSIONS: These results suggest that both caregivers and physicians lack ready understanding of the difference between memory processes in aging and AD. Ongoing public and professional education is needed to convey the basics of the diagnosis of AD. In addition, routine screening for dementia should be considered to surmount attitudinal and logistical barriers.